The accurate description of the anatomic alterations in physiological sequellae of congenital cardiac malformations has depended traditionally upon cardiac catheterization of selective angiocardiography. These techniques are associated with substantial risk in the neonatal period and lesser, although still significant, risk in small children. Thus, the development of accurate non-invasive methods to assist in the diagnosis and management of heart disease is of particular importance in the pediatric age group. The specific aim of this proposal is to develop and refine three non-invasive modalities whose combined applications may be expected to significantly improve the clinical approach to the infant or child with heart disease. The techniques to be employed include phased multiple crystal echocardiography, pulsed Doppler echocardiography, and scintillation scanning of the heart and lungs. Scintillation scanning will be employed primarily to assess the magnitude of intercirculatory shunting. The goal of the ultrasonic instrument development program is to assemble an ultrasonic echographic system utilizing, in combination, the technologies of multiscan echocardioraphy, pulsed Doppler velocity indication, phased array beam steering, and moving target indicator techniques in order to provide a high resolution image of internal soft tissue structures. It is our conviction that these new approaches will provide a significantly improved image of cardiac and vascular structures, and, thus, enhance the capability for atraumatic description of cardiovascular morphology and function in infants and children. BIBLIOGRAPHIC REFERENCES: McPherson, R.A., Kramer, M.F., Covell, J.W., and Friedman, W.F.: A comparison of the active stiffness of fetal and adult cardiac muscle. Ped. Rsrch. 10: 660-664; 1976. Friedman, W.F., Heymann, M.A., and Rudolph, A.M.: Commentary: New thoughts on an old problem - patent ductus arteriosus in the premature. J. Peds. 90: 338-340, 1977.